The prognostic value of lymph node ratio for local advanced gastric cancer patients with adjuvant chemoradiotherapy after D2 gastrectomy

This study aimed to find the prognostic factors of local advanced gastric cancer patients with adjuvant concurrent chemoradiotherapy after radical D2 gastrectomy, and explore the prognostic value of lymph node ratio (LNR). We retrospectively analyzed 164 gastric cancer patients enrolled in West China Hospital from 2006 to 2013, who underwent D2 radical gastrectomy and adjuvant chemoradiotherapy. With univariate analysis and the Cox regression model, we evaluated the association of LNR and other clinical pathological characteristics with overall survival (OS) and relapse-free survival (RFS) of patients. Of 164 gastric cancer patients, the median age at diagnosis was 60 (IQR 51-66), with 121 males (73.78%) and 43 females (26.22%). The median follow-up time was 41.5 months. One-year and 3-year OS rate of the whole cohort was 97.6% and 88.4%, with 1-year RFS rate of 90.2% and 3-year RFS rate of 76.8%, respectively. In the univariate analysis, we found that age >60years (P=.025), TNM stage III (P=.014), LNR >0.25 (P=.006) and radiation dose <45Gy (P=.048) predicted worse OS. Further multivariate analysis indicated that age >60y (HR 2.375, 95% CI 1.100-5.128; P=.028), TNM stage III (HR 7.692, 95% CI 1.009-58.824; P=.049) and LNR >0.25 (HR 2.439, 95% CI 1.075-5.525; P=.033) were independent prognostic factors for unfavorable OS. The COX analysis showed that related prognostic factors of worse RFS were TNM stage III (HR 3.802, 95% CI 1.506-9.615; P=.049) and LNR >0.25 (HR 2.326, 95% CI 1.332-4.065; P=.003). LNR can be used as an important prognostic indicator for gastric cancer patients with D2 resection and adjuvant chemoradiotherapy, and LNR more than 0.25 indicates poor prognosis.